Schedule 1/7a (Form 4785) - Schedule Of Terminal Operator Inventories

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DLN
MISSOURI DEPARTMENT OF REVENUE
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FORM
TAXATION DIVISION
P.O. BOX 300, JEFFERSON CITY, MO 65105-0300
4785
(573) 751-2611
TDD 1-800-735-2966
SCHEDULE OF TERMINAL OPERATOR INVENTORIES
PAGE
(REV. 02-2011)
SCHEDULE 1/7A
OF
SEE INSTRUCTIONS ON REVERSE SIDE
TERMINAL OPERATOR
TERMINAL CODE
LICENSE NUMBER
FEIN
MONTH, YEAR
__ __ __ __ __ __ __ __ __
___ ___ / ___ ___ ___ ___
PRODUCT TYPE (CIRCLE ONE)
065 — Gasoline
124 — Gasohol
142 — Kerosene
228 — Dyed Diesel Fuel
290 — Bio-Diesel – Dyed B100
123 — Alcohol
125 — Aviation Gasoline
072 — Dyed Kerosene
284 — Bio-Diesel – Undyed B100
122 — Blending Components (Identify)
241 — Ethanol
130 — Jet Fuel
160 — Diesel Fuel
285 — Soy Oil
1
2
3
4
5
6
7
SUPPLIER
SUPPLIER FEIN
BEGINNING INVENTORY
TOTAL RECEIPTS
TOTAL DISBURSEMENTS
GAIN (LOSS)
ENDING INVENTORY
__ __ __ __ __ __ __ __ __
__ __ __ __ __ __ __ __ __
__ __ __ __ __ __ __ __ __
__ __ __ __ __ __ __ __ __
__ __ __ __ __ __ __ __ __
__ __ __ __ __ __ __ __ __
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__ __ __ __ __ __ __ __ __
0
0
0
0
PAGE TOTAL
SCHEDULE TOTAL
This publication is available upon request in alternative accessible format(s).
MO 860-2851 (02-2011)

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